Perforated balloon and method for forming a hardened orthopaedic paste in a bone using same

ABSTRACT

The present invention discloses a technique for forming a hardened orthopaedic paste in a bone cavity, which involves a forced-feeding balloon rupture mechanism. This mechanism includes continuously or intermittently injecting a liquid or gas into a perforated balloon containing a hardened orthopaedic paste therein in a bone cavity until the perforated balloon is dilated to exceed a critical size, and thus ruptures.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a divisional of U.S. patent application Ser.No. 12/155,273, filed on Jun. 2, 2008, disclosure of which isincorporated herein by reference. The parent application Ser. No.12/155,273 is a continuation-in-part application of U.S. patentapplication Ser. No. 11/919,655, filed Oct. 31, 2007. This patentapplication claims the benefit under 35 USC 119(e) of U.S. ProvisionalPatent Application No. 60/932,586, filed Jun. 1, 2007.

FIELD OF THE INVENTION

The present invention is related to a technique for forming a hardenedorthopaedic paste in a bone by inserting a perforated balloon in thebone, injecting an orthopaedic paste into said balloon, which willharden in-situ, and rupturing the balloon to leave the hardened paste inthe bone, acting as a medical implant. The orthopaedic paste can be anyknown flowable orthopaedic filling material including, for example, aliquid-powder mixture and a viscous liquid containing a polymericmaterial.

BACKGROUND OF THE INVENTION

It is well accepted that bioresorbable orthopedic implants are alwaysthe better choice than permanent foreign-body implants, as long as theirbioresorption rates, biomechanical properties and variations inbiomechanical properties with respect to the resorption processes areappropriately controlled. Among all bioresorbable orthopedic implants,calcium-based implants (calcium phosphate, calcium sulfate, etc), areperhaps the top choice so far.

For the purpose of filling a bone cavity, especially anirregularly-shaped bone cavity, a bone cement paste (for example, aPMMA, calcium phosphate cement or calcium sulfate cement) is ofteninjected into the cavity, wherein the bone cement paste is hardenedin-situ. This hardened cement will remain in bone as a permanent implantif it is a permanent foreign-body implant such as PMMA, or graduallyreplaced by natural bone if it is a bioresorbable material such ascalcium phosphate or calcium sulfate. For load-bearing applications,this hardened cement should provide a sufficient strength to withstandthe post-operation routine loadings.

Most conventional methods of forming a hardened (set) bone cement inbone cavity involve creating a bone cavity, followed by directlyinjecting a cement paste into the bone cavity. Such an approach suffersthe following major drawbacks among others:

-   (1) Since the cement paste is directly injected into an environment    filled with blood/body fluid, the cement particles are easily    dispersed in this environment, especially before the paste is fully    set. The dispersed cement particles can penetrate into surrounding    tissues, cracks, blood vessels, nerve system, etc. and cause various    kinds of clinical complications such as potentially fatal cement    embolism.-   (2) Since the cement paste is hardened in blood/body fluid, the    predetermined liquid/powder ratio, which is critical to cement    properties, is disrupted in-situ, causing the performance/properties    of the cement to degrade. Although applying pressure to the cement    during its hardening process can improve the cement strength,    surgeons usually avoid applying a high pressure directly to the    injected cement paste due to the above-mentioned potential risks of    complications.-   (3) Besides the disruption in liquid/powder ratio, the irregular    shape of the hardened cement also decreases the biomechanical    properties of the cement and increases the uncertainty/risks of the    cement performance (depending on the actual shape and filling    condition), especially for bioceramic cements such as calcium    phosphate cement and calcium sulfate cement. The decreased strength    further causes the cement to more easily disperse/disintegrate.

Another approach to inject an orthopedic implant into a bone cavityinvolves inserting a container (balloon or pocket) into the cavity;injecting a bone filler (not necessarily a hardenable cement paste) intothe container through a tube; and separating the container from the tubewith the container and its contained bone filler remaining in bone. Onemajor problem with this approach is that the container left in bonebecomes a permanent foreign body which prevents the bone filler fromdirectly interacting with bone tissue to form a biological or even onlya chemical or physical bond between the bone filler and bone.Furthermore, most popularly-used containers (balloons) are made frompolymers which are not bioactive, bioconductive, or even biocompatible.The negative effects of this permanently implanted container are mostobvious when the bone filler is a bioresorbable material, such as acalcium phosphate or calcium sulfate-based material. In this case even abiodegradable polymer container hinders the bioresorption process of thebioresorbable bone filler for a season, especially during the mostcritical early stage resorption/healing process. Furthermore, mostbiodegradable polymers do not demonstrate mechanical properties asdesired.

An improved method for forming a hardened cement in a bone cavityinvolves inserting an inflatable, preferably inflatable and expandable,pocket into a bone being treated; injecting a hardenable cement pasteinto the pocket through a tube which connects and carries the pocketinto the bone; allowing the cement paste to harden within the pocket inthe bone cavity; opening the pocket; separating the pocket from thehardened cement, and retrieving the opened pocket from the bone with thehardened cement remaining in the bone. Advantages of this method includeallowing the hardened cement implant to directly contact the surroundingbone tissue thus enhancing the healing process, and the much higherstrength of the hardened cement compared to that of the cement pastedirectly injected into the bone cavity. This is especially advantageousfor bioresorbable implants. A typical example can be found in U.S. Pat.No. 7,306,610 B2.

A further improved method for forming a hardened cement in a bone cavityinvolves inserting an inflatable, preferably inflatable and expandable,pocket into a bone being treated; injecting a hardenable cement pasteinto the pocket through a tube which connects and carries the pocketinto the bone, therein said pocket is made from a material penetrable toliquid but substantially impenetrable to the powder of said cementpaste; allowing the cement paste to harden within the pocket in the bonecavity; opening the pocket; separating the pocket from the hardenedcement, and retrieving the opened pocket from the bone with the hardenedcement remaining in the bone. A primary advantage of this method isallowing a portion of the liquid contained in the cement paste to beexpelled out of the pocket, especially when a pressure is applied untosaid cement paste before said cement paste is substantially hardened, sothat the powder/liquid ratio of said cement paste in said pocket isincreased and the strength of the hardened cement is further increased.This further increase in cement strength is especially advantageous forthe relatively weak ceramic, calcium-based cement. A typical example canbe found in U.S. Pat. No. 7,144,398 B2. Nevertheless, one majordifficulty in practicing this method is the accurate control of theselective penetrability (only to liquid) of the pocket, especiallyduring the expansion process, wherein the volume of the pocket continuesto increase while the thickness of the pocket continues to decrease.

SUMMARY OF THE INVENTION

The present invention further improves the existing methods for forminga hardened cement in a bone cavity by disclosing an inflatable andexpandable balloon with a designed perforation pattern through themembrane of said balloon, wherein the perforation pattern (perforationsize, population, and distribution, etc) can be designed and controlledso that the balloon is penetrable to liquid but substantiallyimpenetrable to the powder of the cement paste under an expandedcondition. The present invention further discloses a “forced-feeding”method for opening (rupturing) a balloon after its contained cementpaste is substantially hardened. A brief description of the presentinventive method and device is given below.

The Method

-   1. A method for treating a bone comprising    -   (a) preparing a cement paste from a powder and a liquid, so that        said cement paste is injectable through a syringe;    -   (b) inserting a perforated balloon into said bone, therein said        perforated balloon comprising at least one perforation through        the membrane of said balloon; therein the size of said        perforation can be controlled so that the balloon is penetrable        to liquid but substantially impenetrable to the powder of said        cement paste under expanded condition;    -   (c) injecting said cement paste into said perforated balloon,        wherein said injecting is carried out with a means which is able        to be operated outside said bone cavity;    -   (d) applying a pressure unto said cement paste before said        cement paste is substantially hardened, causing a portion of        said liquid contained in said cement paste to be expelled out of        said perforated balloon, so that the powder/liquid ratio of said        cement paste in said perforated balloon is increased;    -   (e) allowing said cement paste at least partially harden in said        balloon;    -   (f) rupturing said balloon, wherein said rupturing is carried        out with a means which is able to be operated outside said bone        cavity, and the resulting ruptured balloon is attached to said        means;    -   (g) separating the resulting ruptured balloon from the hardened        cement, wherein said separating is carried out by removing the        resulting ruptured balloon from said bone cavity with the        hardened cement remaining in said bone cavity.-   2. The method in (1) further comprising preparing a minimally    invasively percutaneous path for the balloon to be inserted into the    bone being treated.-   3. The method in (2) further comprising inserting an injection tube    into the bone through said percutaneous path, wherein the balloon is    connected to or near distal end of said injection tube; through said    tube the cement paste is injected into the balloon, wherein the    balloon is dilated by the injection of said paste.-   4. The perforated balloon in (1b) further comprising multiple    perforations through the membrane of said balloon; wherein said    multiple perforations comprise a first type of perforations capable    of functioning as channels through which a portion of the liquid    contained in the cement paste inside the expanded balloon can be    expelled out of the balloon.-   5. The perforated balloon in (1b) further comprising multiple    perforations through the membrane of said balloon; wherein said    multiple perforations comprise a second type of perforations    designed for being able to function as weak spots, wherein said    rupturing in (1f) can preferentially occur at or along said    predetermined (designed) weak spots.-   6. Said second type of perforations in (5) further comprising at    least one perforation array (a “dotted line” of perforations),    preferably located at the opposite side to the neck of the balloon    (the leading/top portion of the balloon), wherein the rupturing of    the balloon can preferentially occur at or along said weak spots    when the balloon is dilated and is subjected to an interior or    exterior force. Optionally said second type of perforations comprise    multiple perforation arrays, preferably located at the opposite side    to the neck of the balloon, comprising designed patterns of pores,    dents, notches, grooves, cuts, etc. made on the surface of at least    a portion of the balloon. Preferably the perforation arrays converge    around the apex of the balloon, creating a most weakened area where    rupturing cracks would initiate.-   7. The first type of perforations in (4) and second type of    perforations in (5) and (6) are optionally the same perforations,    wherein said same perforations are designed to function as both    channels through which a portion of the liquid contained in the    cement paste inside the balloon can be expelled out of the balloon    under expanded condition, and as weak spots wherein said rupturing    in (1f) can preferentially occur at or along said weak spots.-   8. Said rupturing in (1f), (5)-(7) is assisted by means of a    forced-feeding mechanism, wherein said forced-feeding is    characterized by, after said cement paste is substantially hardened,    further injecting a biocompatible fluid (water, oil, etc) into the    balloon at a flow rate greater than that of the fluid leaking out of    the balloon through the perforations to cause said balloon to swell    until it ruptures.-   9. Said rupturing in (1f), (5)-(7) is assisted by means of a cutting    mechanism, wherein said cutting is conducted unto at least a portion    of said balloon, preferably located at the opposite side to the neck    of the balloon with a cutting means, for example, a thin wire or    blade.-   10. Said rupturing in (1f), (5)-(7) is assisted by means of a    thermal softening/melting mechanism, wherein said thermal    softening/melting is conducted with an energy directed by an    electrically, thermally or optically conductive wire embedded in at    least a portion of said balloon, preferably located at the opposite    side to the neck of the balloon.-   11. The method in (1) further comprising, prior to inserting a    balloon into the bone, creating a cavity and/or restoring at least a    portion of height of the bone being treated, wherein the volume of    the first bone filler injected into the balloon can be controlled to    either avoid further expanding the bone, or to further expand the    bone.-   12. The balloon is preferably made from an inflatable, preferably    inflatable and expandable, polymeric material (PU, rubber, etc),    although any other material in any form (fabric, mesh, etc) which    may serve the purpose may be used.-   13. The sizes of the perforations in (1), (4)-(7) are substantially    less than the particle size of the powder in the cement paste so    that liquid can be squeezed out but cement powder cannot penetrate    through the perforations. Preferably the perforation sizes are less    than 10 microns, and more preferably less than 1 micron.-   14. Said powder in said cement paste in (1a) is made from a    biocompatible material, preferably a biocompatible and bioconductive    material, more preferably a biocompatible, bioconductive and    bioresorbable material.-   15. Optionally a wire or thread can be connected to any part of the    balloon, preferably at the opposite side to the neck of the balloon,    as a safety device, wherein, in case a portion (piece) of the    ruptured balloon is broken off, the broken-off portion can be    retrieved by the connected wire/thread independently.-   16. The bone being treated is preferably a diseased or fractured    vertebral body.

The Device

-   A. A perforated balloon for entrapping a cement paste for treating a    bone until the paste is hardened inside the balloon in a bone    cavity; wherein the perforated balloon is adapted to be mounted on    an end of an injection tube of a cement paste delivering tool    through which the paste is injected into the balloon and the balloon    is dilated by the injection of the cement paste; wherein said    perforated balloon comprising at least one perforation through the    membrane of said balloon; wherein the size of said perforation can    be controlled so that the balloon is penetrable to liquid but    substantially impenetrable to the powder of said cement paste under    expanded condition.-   B. The perforated balloon in (A) further comprising multiple    perforations through the membrane of said balloon; wherein said    multiple perforations comprise a first type of perforations capable    of functioning as channels through which a portion of the liquid    contained in the cement paste inside the expanded balloon can be    expelled out of the balloon.-   C. The perforated balloon in (A) further comprising multiple    perforations through the membrane of said balloon; wherein said    multiple perforations comprise a second type of perforations    designed for being able to function as weak spots, wherein said    rupturing of the balloon can preferentially occur at or along said    predetermined (designed) weak spots.-   D. The second type of perforations in (C) further comprising at    least one perforation array (a “dotted line” of perforations),    preferably located at the opposite side to the neck of the balloon    (the leading/top portion of the balloon), wherein said rupturing of    the balloon can preferentially occur at or along said weak spots    when the balloon is dilated and is subjected to an interior or    exterior force. Optionally said second type of perforations comprise    multiple perforation arrays, preferably located at the opposite side    to the neck of the balloon, comprising designed patterns of pores,    dents, notches, grooves, cuts, etc. made on the surface of at least    a portion of the balloon. Preferably the perforation arrays converge    around the apex of the balloon, creating a most weakened area where    rupturing cracks would initiate.-   E. The first type of perforations in (B) and second type of    perforations in (C) and (D) are optionally the same perforations,    wherein said same perforations are designed to function as both    channels through which a portion of the liquid contained in the    cement paste inside the balloon can be expelled out of the expanded    balloon, and as weak spots wherein said rupturing of the balloon can    preferentially occur at or along said weak spots.-   F. Said rupturing of the balloon in (C)-(E) is assisted by a    forced-feeding mechanism, wherein said forced-feeding is    characterized by, after said cement paste is substantially hardened,    further injecting a biocompatible fluid (water, oil, etc) into the    balloon at a flow rate greater than that of the fluid leaking out of    the balloon through the perforations to cause said balloon to swell    until it ruptures.-   G. Said rupturing of the balloon in (C)-(E) is assisted by pulling    or twisting the injection tube while pushing the substantially    hardened cement by inserting a stylet into the tube while holding    the tube after the cement paste is substantially hardened inside the    balloon.-   H. Said rupturing of the balloon in (C)-(E) is assisted by a cutting    mechanism, therein said cutting is conducted unto at least a portion    of said balloon, preferably located at the opposite side to the neck    of the balloon, with a cutting means, for example, a thin wire or    blade.-   I. Said rupturing of the balloon in (C)-(E) is assisted by a thermal    softening/melting mechanism, therein said thermal softening/melting    is conducted with an energy directed by an electrically, thermally    or optically conductive wire embedded in at least a portion of said    balloon, preferably located at the opposite side to the neck of the    balloon.-   J. The sizes of the perforations in (A)-(E) are substantially less    than the particle size of the powder in the cement paste so that    liquid can be squeezed out but cement powder cannot penetrate    through the perforations. Preferably the perforation sizes are less    than 10 microns, and more preferably less than 1 micron.-   K. The balloon membrane preferably has a substantially uniform    thickness and a predetermined shape.-   L. The balloon is preferably made from an inflatable, preferably    inflatable and expandable, polymeric material (PU, rubber, etc),    although any other material in any form (fabric, mesh, etc) which    may serve the purpose may be used.-   M. Said powder in said cement paste is made from a biocompatible    material, preferably a biocompatible and bioconductive material,    more preferably a biocompatible, bioconductive and bioresorbable    material.

O. Said biocompatible material in (M) comprising a calcium-basedcompound comprising calcium phosphate, calcium sulfate, bioactive glassor their composites.

-   P. Said cement paste is further doped with a relatively strong and    rigid biocompatible phase, such as calcium phosphate particles,    calcium sulfate particles, or bioactive glass particles or their    composites, for improving strength of said cement.-   Q. Said cement paste is further doped with a BMP, a growth factor    (e.g., a bone marrow or blood-derived growth factor), or living    cells for enhancing bone resorption/healing processes.-   R. Optionally a wire or thread can be connected to any part of the    balloon, preferably at the opposite side to the neck of the balloon,    as a safety device, wherein, in case a portion (piece) of the    ruptured balloon is broken off, the broken-off portion can be    retrieved by the connected wire/thread independently.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic front view of a perforated balloon for entrappingan orthopaedic paste in a bone cavity until the paste is hardened in abone cavity disclosed in the present invention.

FIG. 2 is a schematic side view of the perforated balloon shown in FIG.1.

FIG. 3 is a schematic side view of a cement-filled balloon underforced-feeding by fluid.

FIG. 4 is a schematic side view showing a representative implementationof forced-feeding by connecting the balloon rear end to a syringe.

DETAILED DESCRIPTION OF THE INVENTION

As bone cement paste is delivered into a balloon made from elasticmaterial (for example, a polymeric PU), surface tension will be createddue to the stretch of the balloon membrane. The pressure differential(ΔP) across membrane is proportional to the surface tension andinversely proportional to the radius of curvature of the balloon:

$\begin{matrix}{{\Delta \; P} = {{P_{b} - P_{a}} = \frac{2\; \gamma}{R}}} & (1)\end{matrix}$

wherein P_(b) is the pressure inside the balloon, P_(a) is the pressureoutside the balloon, r is the diameter of the perforations, and R is theradius of curvature of the balloon. The static equilibrium between thepressure differential across the membrane and the surface tension setsan ideal stage for cement to solidify. In order to expel air or watertrapped originally in the balloon before cement delivery, tinyholes/perforations were made as venting flow passages distributed in themembrane wall. These tiny holes serve two major roles for bone cementdelivery, one as the air/water filter and another as the crack initiatorfor the subsequent balloon rupture.

In order for the balloon to be ruptured in a predetermined (designed)manner (pattern) after the cement is hardened, “perforation array” isdesigned, for example the perforation array 210 shown in FIGS. 1 and 2.The perforation array 210 is used mainly to rupture the inflated balloon200 with predetermined lines/pattern of breakup, although permeabilityeffect is also provided therein when the pore size is carefullycontrolled. The perforation array is also designed to keep the entireruptured balloon to remain attached to the injection tube end afterbeing ruptured. Without this design, it is highly likely that somerandom pieces of the ruptured balloon are detached from the balloon andleft permanently in the bone cavity. Ideally the entire balloon shouldremain attached to the injection tube after being ruptured and can beentirely withdrawn along with the tube.

The perforation array 210 comprises designed patterns of pores, dents,notches, grooves, cuts, etc. and are made on the surface of at least aportion of the balloon. Such pores, dents, notches, grooves, cuts, etc.can be made by any conventional methods. Preferably, these pores, dents,notches, grooves, cuts, etc. are made at or near the central part of theballoon. Preferably, the “lines of perforation” converge around the apexof the balloon, creating relatively weakened spots where rupturing crackwould initiate.

Such parameters as pore size, population, spacing between perforations,number of perforation array, and the array size are to be controlled andoptimized to result in a required structural characteristics of theballoon.

Although permeability (draining) effect is provided in the design of theperforation array, in order to more effectively drain water and air outof the balloon as the cement paste is injected to fill the bone cavity,micro-pores 220 can be further incorporated over the surface of theballoon 200. These micro-pores can be distributed randomly or in adesigned manner/pattern and will be progressively enlarged as cementmixture is continually delivered into the balloon.

The perforations of the perforation array 210 and the micro-pores 220 ofdesired diameters and optionally desired distribution (pattern) can bemade mechanically (for example, by needle drilling), chemically (forexample, by etching/dissolving) or thermally (for example, by focusedheat or laser drilling). The perforations/pores can be made on an emptyballoon, a balloon still attached onto a substrate mode (for example, aballoon made by dipping a balloon-shaped substrate mode of a desiredsize and shape in a PU solution), or a pre-expanded balloon with aninfilling material.

As perforations/pores are made on a pre-expanded balloon, the infillingmaterial can be any material which can be delivered into and expand theballoon, and removed from the balloon after perforations are made on theexpanded balloon. The infilling material is preferably a high-viscositypowder-liquid mixture paste which will not set/harden in a short periodof time after mixing (for example, a CaO powder/water mixture). Theballoon can be pre-expanded to any desired size whereas perforations aremade. One advantage for perforations/pores made on a pre-expandedballoon is its easier control in perforation quality, since the balloonsurface is enlarged during expansion.

As a balloon swells to certain critical size, the internal stressesdeveloped in the stretched membrane will reach the balloon fracturestress threshold. The corresponding strain at balloon fracture can beconverted into the rupture volume of the balloon. When balloon is filledwith any material which expands the balloon to this critical volume,balloon will fracture spontaneously and the fractured balloon membranewill shrink to its zero-stress state size. Balloon extraction can hencebe achieved while leaving the solidified cement deployed in thedesignated bone cavity.

FIG. 3 shows a cement-filled balloon under forced-feeding by fluid. Asthe feeding pressure destroys the initial static equilibrium thesolidified cement will be lifted up immediately with an inlet flowpassage created around the feeding entrance, followed by a filling ofthe balloon due to the infused fluid volume. Any fluid, gas or liquid,can be used as the filling material so long as it is biocompatible.These fluid fillers first separate the balloon membrane from thesolidified cement surface, greatly reducing the contact friction bygenerating a layer of fluid buffer. Then a further injection of fluidfiller will expand the balloon until balloon rupture is accomplished.According to the mass conservation of fluids, the rate of mass incrementcontained in the balloon closure is equal to the net mass flux convectedthrough the inflow/outflow tracts:

$\begin{matrix}{{\rho \frac{V}{t}} = {{\sum\limits_{i}{\rho \; Q_{i}^{in}}} - {\sum\limits_{i}{\rho \; Q_{i}^{out}}}}} & (2)\end{matrix}$

in which, V is the volume and ρ is the density of the fluid while Q_(i)^(in) and Q_(i) ^(out) are the inflow and outflow volume flowrates,respectively. For the case illustrated in FIG. 3, Q_(i) ^(in) is theforced-feeding influx and

$\sum\limits_{i}Q_{t}^{out}$

is the net outflux contributed by all the leakage flows across themicro-pores and perforations in the membrane wall. So long as the volumeflux of the inflow is greater than that of the outflow, the balloon willkeep on swelling until it ruptures.

FIG. 4 shows a representative implementation by connecting the balloonrear end to a fluid filler such as a syringe 100 having a fluidreservoir 110. Any decrease of the reservoir volume by pushing thesyringe 100 from behind, with sufficiently force and speed, may resultin a net volume infusion into the balloon. Balloon will rupture as theaccumulated fluid mass increases and the resultant membrane stressesreach the rupture threshold value.

To reduce the risk that a portion (especially the leading/top portion)of ruptured balloon (especially for rupture occurring around thebelly/equator portion of the balloon) being trapped in the cavity whenthe ruptured balloon is retrieved from the cavity site, a thread can beconnected to any part of the balloon as a safety device. Since theleading/top portion is one that most easily breaks off the balloonduring rupture, the thread can be connected (for example, by glue) tosuch location. In case a portion of ruptured balloon is broken off, thebroken-off piece can be retrieved by the connected wire/threadindependently.

1. A method for forming a hardened orthopaedic paste in a bonecomprising continuously or intermittently injecting a liquid or gas intoa perforated balloon containing a hardened orthopaedic paste therein ina bone cavity until the perforated balloon is dilated to exceed acritical size, and thus ruptures.
 2. The method as defined in claim 1further comprising inserting a major portion of said perforated balloonin said bone cavity before injecting said orthopaedic paste into saidperforated balloon, wherein said perforated balloon comprises a neckadapted to be mounted on an end of a tube through which said orthopaedicpaste is injected into the perforated balloon; and leaking perforations,wherein said leaking perforations have a size which is penetrable toliquid contained in said orthopaedic paste but substantiallyimpenetrable to powder contained in said orthopaedic paste under anexpanded condition of said perforated balloon, in which a rupture arrayis formed on said perforated balloon for initiating said rupture of saidperforated balloon when the perforated balloon is dilated to exceed saidcritical size.
 3. The method as defined in claim 2 further comprisingretrieving the ruptured balloon from the bone cavity by pulling saidtube to leave the hardened orthopaedic paste in the bone cavity.
 4. Themethod as defined in claim 2, wherein a forced-feeding mechanism havinga liquid or gas reservoir is connected to another end of the tube, andsaid liquid or gas is continuously or intermittently injected from thereservoir into the perforated balloon through said tube by applying aforce to said forced-feeding mechanism, until the perforated balloon isdilated to exceed said critical size.
 5. The method as defined in claim4 wherein said forced-feeding mechanism is a syringe.
 6. The method asdefined in claim 2, wherein said rupture array comprises pores, dents,notches, grooves or cuts formed on said perforated balloon, whichfunction as weak spots so that said rupture occurs along at least aportion of said weak spots.
 7. The method as defined in claim 2, whereinsaid rupture array is located in a region opposite to said neck of saidperforated balloon.
 8. The method as defined in claim 2, wherein saidweak spots form one or more dotted lines.
 9. The method as defined inclaim 7, wherein said weak spots form one dotted line across an apex ofthe perforated balloon or more dotted lines intersect at an apex of theperforated balloon.
 10. The method as defined in claim 2, wherein saidrupture array comprises pores having a size which is penetrable toliquid contained in said orthopaedic paste but substantiallyimpenetrable to powder contained in said orthopaedic paste under anexpanded condition of said perforated balloon.
 11. The method as definedin claim 10, wherein said pores constitutes a portion of said leakingperforations.
 12. The method as defined in claim 10, wherein said poresconstitutes whole said leaking perforations.